Research shows that timely access to high quality ambulatory care has been a persistent problem in the U.S. health care system. Studies have estimated, for example, that in 2006 nearly $31 billion was spent on 4.4 million ambulatory care sensitive hospitalizations (ACSH), accounting for nearly 10 percent of total hospital expenditures and nearly 1 in 5 Medicare admissions. High rates of potentially avoidable ACSH are a serious challenge for the U.S. health care system because they often reflect unnecessary, poor quality care with significant cost implications for a resource constrained system, especially among vulnerable populations, such as minorities and the elderly. The focus on improving access to care coincides with another trend in health care - the expectation that hospitals will adopt and utilize principles of population health management to better serve the communities they serve. Prior research, however, has not examined how hospitals have responded to increasing pressure to adopt these practices and whether their adoption has any impact on access to and quality of ambulatory care in local communities in ways that may reduce potentially avoidable utilization. Our study will address the following aims: 1: To examine the changes in two indicators of hospitals' population health activities - community orientation and health promotion services - over time and assess whether these changes vary as a function of different types of hospitals. 2: To explore whether changes in community orientation and health promotion services are differentially associated with potentially avoidable ACSH rates for different racial/ethnic groups among older adults. 3: To analyze whether the relationship between community orientation, potentially avoidable ACSH rates is mediated by the level of health promotion and whether this mediational influence differs for different racial/ethnic groups among older adults. 4: Strengthen the capacity of the Department of Health Services Administration (HSA) to conduct high-impact research on health services for minority aging through mentoring of undergraduate and graduate faculty and students. The study will use linear growth curve models to examine changes (2009-2012) in hospital adoption of community orientation and health promotion activities and assess whether these changes are differentially associated with rates of chronic ACSH for different racial/ethnic groups. The analytic sample for the quantitative analysis consists of ACSH for older adults (55 and older) in six states: California, Florida, Michigan, New York, South Carolina, and Texas. The proposed study will help illuminate the effects of current policies designed to reduce avoidable inpatient care. Our study also promotes understanding of hospital and community factors that may contribute to racial/ethnic disparities in unnecessary ACSH, which addresses an important gap in the literature. The project will provide the opportunity to engage undergraduate and graduate faculty and students in the conduct of high- quality research on health services for minority aging, thereby helping to build the HSA research capacity.